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DWI Education BD-1Brian Knaack2022-08-11T00:29:21-05:00

What happened during your arrest?

"*" indicates required fields

Name*

First Middle Initial Last

Email*

What is the reason you were stopped?*

Speeding

Driving too slow

Light(s) not working

Had a wreck

Other Moving violation

Other

In which county did your arrest occur?*

Did you take a breath test?*

Yes

No

What was the result?*

Why was a breath test not taken?*

Was a blood test taken?*

Yes

No

What was the result of the blood test?*

Before my arrest, I was:*

Check all that apply.

Drinking alcohol after work

Engaged in a recreational activity while using alcohol (or drugs), i.e. ball game, party, work function, etc.

Coping with problems (relationship, work, family, etc.)

Other

I had been using:*

Check all that apply.

Beer

Wine

Liquor

Marijuana

Opiates

Pills

Methamphetamines

Other

I was with:*

Check all that apply.

Spouse

Friend(s)

Co-workers

Family

Stranger/Other

Alone

Summarize any other comments about your alcohol/drug usage and the events leading up to your arrest.

Optional

Hidden

Course Date

MM slash DD slash YYYY

Title

Page load link

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